Children with cerebral palsy
Description
Cerebral palsy is a term describing a group of muscle and nerve
disorders that affect a child's ability to move. Cerebral palsy is not
an ongoing disease process, but a condition caused by damage to the immature
brain. As the child ages, however, the resulting level of disability can
progress. For this reason, a child with cerebral palsy requires skillful,
ongoing care.
The level of physical and mental disability found with cerebral palsy varies from child to child. Not all children with this condition have mental retardation. In fact, fewer than two thirds of all children with cerebral palsy have cognitive delay. Because cerebral palsy can limit a child's ability to communicate, it is often difficult to determine the child's mental abilities.
Common forms of cerebral palsy include:
- Ataxia - Poor coordination, difficulty in maintaining balance, an awkward gait, and abnormal depth perception.
- Spasticity - Muscular stiffness, over-reaction, and tightness, often due to oversensitive stretch reflexes.
- Athetosis - Slow, wave-like involuntary movements that are without purpose.
- Choreoathetosis - Involuntary, abrupt, rapid, rhythmic
movements.
Of the children who have cerebral palsy, approximately 60% have spasticity. About 20% have athetosis or choreoathetosis. Between 25% and 30% have a combination of symptoms, usually with one predominant form. Only 1% has ataxia. The involuntary movements caused by cerebral palsy will often increase during times of stress.
Etiology
Damage to higher brain centers in the immature brain often results in
cerebral palsy. For nearly 40% of all children with this disorder, we
don't know what causes the damage. Cerebral palsy may occur as the result
of factors found:
- Prenatally (before birth) - Anoxia (lack of oxygen), radiation exposure, drugs that harm the fetus, genetic disorder, fetal stroke, injury, infection of the uterus or kidney, toxemia, anemia, Rh factor, rubella.
- Perinatally (around the time of birth) - Anoxia, Rh factor, high bilirubin levels, injury.
- Postnatally (after a child is born) - Anoxia; injury; infections such as toxoplasmosis, meningitis; other central nervous system disease.
Incidence
Cerebral palsy occurs in about 2 of every 1000 live births.
Diagnosis
Cerebral palsy can be difficult to diagnose in very young children. Symptoms
include:
- Delay in reaching motor milestones, such as sitting or walking. Diagnosis is based on the rate, pattern, and level of motor skill development.
- Abnormal movement, muscle tone that is too low (hypotonia) or too high (hypertonia).
- Unusual reflexes, such as a very active knee-jerk; persistent primitive reflexes.
Although early diagnosis may be difficult, it is very important. Early intervention can greatly improve outcomes, for both the child and the family. If you have concerns about your child's development, talk with your doctor to arrange a developmental or neurological screening.
Outlook
Today, the long-term outlook for children with cerebral palsy continues to improve as the result of:
- Early intervention.
- The development of ongoing care strategies that can prevent increasing levels of disability.
- Advances in medicine, physical and occupational therapy, assistive technology, and rehabilitation engineering.
| Children
with cerebral palsy: |
||
| AREA |
|
MANAGEMENT AND MANAGEMENT RESOURCES |
|---|---|---|
| Childhood illness | Children who cannot move
easily are more likely to have upper respiratory infections.
|
|
| Cognitive development | Cognitive delay (40%).
Very distractible. Repeats sounds, movements. Severe movement disorders can mask normal intelligence.
|
|
| Dental care | Muscle imbalance
can cause uneven tooth wear and malocclusion (poorly aligned bite).
Adults must provide dental hygiene care for children who can't do
this for themselves.
|
|
| Emotional and mental health | Talking with
other families that include children with CP can benefit both child
and family. A social worker or family therapist can guide families to useful resources.
|
|
| Gastrointestinal tract | Constipation
can result from lack of movement, medications, or eating difficulties.
|
|
| Hearing | Hearing impairment
(13.3%). Middle ear infection and hearing loss may occur if child
is prone for long periods of time.
|
|
| Language development | Moderate to
profound vocal communication disorders (70-80%). The muscles that
control speech are often affected. Poor speech can complicate cognitive
assessment.
|
|
| Neuromuscular and musculoskeletal systems | Neuromuscular
involvement -- disorders of nerves and muscles -- can cause increasing
discomfort, skeletal deformity, and disability.
|
|
| Nervous system | Seizures (35% to 60%) often
result from injury to the cortex.
|
|
| Nutrition | Poor muscle
coordination of the mouth, tongue, and throat can make it hard to
eat. A child with significant neuromuscular involvement may need more calories.
|
|
| Vision | Vision impairment (30-40%). Sometimes the muscles that control vision don't work properly. A child can also have "refractive" disorders," such as nearsightedness.
|
|
| Skin | Proper skin care is essential
for children who cannot move easily. Orthotics (braces) or special
seating systems (positioning) may help.
|
|
Resources
Cerebral Palsy: A Resource List .
Keesee, P.D., et al. Your Very Young Child with Cerebral Palsy - An Interdisciplinary Approach . (Center for Disabilities and Development, 1991).
Mecham, M.J. Cerebral Palsy , 2nd ed. (Pro-Ed, 1996).
Miller, M. and S. Bachrach. Cerebral Palsy - A Complete Guide for Caregiving (Johns Hopkins University Press, 1995).
Find more information about this subject in the online catalog of our Disability Resource Library .
